September 18, 2011

The movie, "Contagion," which tracks the global spread of a deadly, flu-like virus, may have some audience members asking if the circumstances surrounding the film could actually happen in the world today.

"The film tells the story about a respiratory virus from Malaysia making its way from bats to swine to humans, and then quickly spreading around the world," explained Lyn Pethtel, SM(ASCP), RN, CIC, Director of Quality Improvement and Infection Control at Salem Community Hospital. "This worst-case scenario of a widespread disease outbreak ends up killing a high percentage of those infected. Even though this type of a scenario could potentially occur, it's extremely unlikely to happen."

According to media reports, the filmmakers enlisted the help of experts to make the story appear more realistic. The producers also sought technical advice from the Centers for Disease Control and Prevention (CDC), and a number of cast members traveled to the CDC to learn how the agency goes about investigating a disease outbreak.

"The film is valuable for focusing attention on the threat of emerging diseases and the need for a strong public health system, which is able to characterize viruses and develop a vaccine," Pethtel continued. "However, movie viewers need to remember that 'Contagion' is a movie designed to attract theater goers, and not a documentary."

The science of viruses, including the process of identifying them and of developing vaccines, continues to evolve. The movie shows that both pandemics and the responses to them take on new dimensions in our information age. A central theme of the movie is that information acts much like a virus and misinformation can cause a wave of mass panic."

Preparing for a Pandemic

Pandemic influenza refers to any of a variety of flu strains that could and have spread throughout the world, with an infection rate that is much larger than is considered statistically "normal."

"Pandemics are unpredictable and are caused by the spread of novel influenza A viruses," Lyn advised. "These viruses may spread from person to person and cause a large degree of human illness, with most of the population being susceptible to the virus."

Three conditions must be met for a pandemic to start:

1. A new influenza virus subtype must emerge for which there is little or no human immunity;

2. It must infect humans and causes illness; and,

3. It must spread easily and sustainably (continue without interruption) among humans.

"Typically, an influenza pandemic occurs roughly three times in a century," stated Ms. Pethtel. "According to the CDC, the most recently documented severe influenza pandemic was in 1918, and about one percent of those who became ill died."

Since 1997, the CDC and other organizations have been tracking the influenza virus, H5N1, sometimes called bird flu. H5N1 continues to be very deadly, with about 60 percent of the people who develop the illness dying. However, the H5N1 virus has been shown to be much less contagious.

In 2009, public health officials began preparing for a pandemic when H1N1 was first recognized in Mexico. At the time, no one could predict if H1N1 was going to be a severe pandemic, and so a vaccine was developed and made available to as many people as possible to prevent an outbreak.

The CDC is constantly on the alert for new, deadly influenza viruses and other airborne diseases. This organization investigates new contagious diseases-averaging one new contagion per year.

Preparedness

"Ongoing planning for a severe pandemic provides us with opportunities to improve our reporting systems, surveillance and diagnostic preparedness," Ms. Pethtel concluded. "The CDC is able to immediately respond to the rapid detection of a new disease organism, and assist with developing a clear understanding of how it is transmitted from person-to-person, and determining what is needed to stop the ongoing transmission.

"If a pandemic should occur, the CDC would conduct an investigation and provide technical assistance to cities, states or local partners, including area hospitals and health care providers, as to how to best manage the outbreak. This would be done in coordination with other global and federal organizations, like the World Health Organization and the Federal Emergency Management Association. The CDC would also send medical teams and first responders to help those in the affected areas. Meanwhile, scientists would be working to identify the cause and cure of the outbreak and then develop a vaccine to distribute to the public. However, according to the scientists that reviewed the movie's timeline related to the outbreak, this process would most likely take longer than was depicted in the film.

"Locally, hospitals and area healthcare providers have developed comprehensive disaster preparedness plans, which provide clear guidance for coordinating and managing a response to a pandemic or other types of emergencies, including natural disasters, chemical or radiation accidents and other types of disease outbreaks. These preparedness plans provide direction for the local organizations in our region to use in successfully responding to an influenza pandemic or a disaster event."

Lyn Pethtel, SM(ASCP), RN, CIC, is the Director of Quality Improvement and Infection Control at Salem Community Hospital.